=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659909901
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIN JEONG KIM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2020
-----------------------------------------------------
Last Update Date | 03/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 W EL CAMINO REAL
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-2216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-967-3531
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 881 E EL CAMINO REAL APT 422
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94040-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH80400
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------